Elisabeth B. Cole

Aspirin protects against Barrett's esophagus in a multivariate logistic regression analysis.

BACKGROUND & AIMS Better criteria are needed to identify patients who should be screened for Barretts esophagus (BE) to reduce overtesting and improve the cost effectiveness. There is evidence that chemopreventive agents such as nonsteroidal anti-inflammatory drugs, particularly aspirin, reduce the risk of esophageal adenocarcinoma (EAC), but little is known about their effects on BE. We analyzed characteristics of patients with BE for factors that might be used in screening and management. METHODS In this case-controlled study, we identified 434 patients with BE diagnosed at the first endoscopy (incident cases) at a single institution (1997-2010). BE cases were matched with controls on the basis of indication for endoscopy, year of endoscopy, and endoscopist. Risk factors analyzed included age, sex, body mass index, medical and social history, and medications. We performed a multivariate logistic regression analysis to identify clinical risk factors for BE. RESULTS In a multivariate regression model, men had a greater risk for developing BE (odds ratio, 3.2; 95% confidence interval, 2.3-4.4), whereas current aspirin users had a lower risk than nonusers (odds ratio, 0.56; 95% confidence interval, 0.39-0.80). A subset analysis, limited to patients who had endoscopies for symptoms of gastroesophageal reflux disease, yielded similar findings. No interactions were found between aspirin use and smoking or use of acid-suppressive medications. CONCLUSIONS In a case-controlled study of 434 patients with BE, current aspirin use appeared to reduce the risk of BE; previous studies associated aspirin use with a reduced risk of EAC. Although efforts were made to minimize biases in our analysis, the possibility of residual confounding remains.

Barriers to enrollment in inflammatory bowel disease randomized controlled trials: An investigation of patient perspectives

Background: Despite a sizeable inflammatory bowel disease (IBD) population in the United States, large trials in IBD have difficulty recruiting patients. Reasons for low enrollment are uncertain. Our objective was to investigate specific barriers to enrollment in clinical trials by determining aspects of study design, disease state, demographics, and previous experiences with research that influence a patients willingness to participate. Methods: Patients with Crohns disease (CD) and ulcerative colitis (UC) at the Massachusetts General Hospital Crohns and Colitis Center were surveyed. Results: Most participants (61%) had participated in some clinical research previously, although 50% of those were not interested in participating in a future study. Frequent doctor visits (69%), requirement of colonoscopy (55%), or sigmoidoscopy (49%), and blinding (46%) were the biggest deterrent study requirements. With each addition of one of these components, potential enrollment fell from 43.2% (86) to 14.6% (29) interested patients. Respondents were likely to participate in studies that were open label (60%), initially randomized then open label (57.6%), or saw the same doctor (52.5%). Among those disinclined to participate, strategies to boost enrollment included monetary compensation, an open‐label component, or providing the same doctor at each visit. Men and patients who were currently flaring were more likely to participate. Conclusions: Elements of study design negatively and positively influence willingness to participate. Invasive procedures, randomization, and frequent visits negatively influenced willingness to participate and as each of these components are added, a significant additive percent of potential subjects are lost. Strategies to further identify barriers to enrollment within IBD study populations should be pursued. (Inflamm Bowel Dis 2012;)

Mo1180 Sustained Leukopenia Not Observed in Patients With Thiopurine-Associated Lymphoma and Ulcerative Colitis

INTRODUCTION: The general increased life expectancy is reflected in the age of patients with inflammatory bowel disease (IBD). The knowledge about efficacy and safety of antitumor necrosis factor (TNF) therapy in elderly is scarce and conflicting. Our objectives were to assess the efficacy and safety of anti-TNF therapy in elderly patients taking into account eventual comorbidity. METHODS: In this retrospective single-centre study we compared 63 IBD patients initiating anti-TNF treatment at age ≥ 65 years (cases) to 118 IBD patients initiating anti-TNF at age 0 were risk factors for malignancy and mortality. CONCLUSION: Elderly patients treated with anti-TNF have a lower rate of clinical response (regardless of their comorbidity). The rate of adverse events is higher in elderly patients but especially in those with a higher comorbidity.

Mo1240 Colorectal Cancer Recurrence Following Partial Colectomy for Colorectal Cancer in Patients With Ulcerative Colitis

+/14.4 years and an average baseline hemoglobin of 132.2+/17.5 g/L. Six patients (3.5%) were found to have adenocarcinomas with 5 in the region of the diverticulitis (descending or sigmoid colon) and one in the transverse colon. There were 61 patients (36.3%) with at least one polyp, 24 (14.3%) were adenomatous, 7 (3.8%) of which were larger than 1 cm. Conclusion: Despite the improvements in CT scan technology providing higher resolution images, patients diagnosed with acute diverticulitis on CT Scan should still undergo follow up colonoscopy to rule out underlying malignancy. Further study is required to determine which features of acute diverticulitis seen on abdominal CT scan most closely correlate with underlying colonic neoplasia.